| South Shore Osteopathic Medicine P.c. | |
|
2409 Ocean Ave Unit 1f Brooklyn NY 11229-3576 | |
| (718) 444-7774 | |
| (718) 444-7775 |
| Full Name | South Shore Osteopathic Medicine P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2409 Ocean Ave Unit 1f, Brooklyn, New York |
| Authorized Official Name and Position | Michael Yuryev (PRESIDENT) |
| Authorized Official Contact | 7184447774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Shore Osteopathic Medicine P.c. 2409 Ocean Ave Unit 1f Brooklyn NY 11229-3576 Ph: (718) 444-7774 | South Shore Osteopathic Medicine P.c. 2409 Ocean Ave Unit 1f Brooklyn NY 11229-3576 Ph: (718) 444-7774 |
| NPI Number | 1063768174 |
|---|---|
| Provider Enumeration Date | 07/26/2012 |
| Last Update Date | 10/04/2019 |
| Medicare PECOS PAC ID | 6800042649 |
|---|---|
| Medicare Enrollment ID | O20120809000326 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063768174 | NPI | - | NPPES |
| A100073001 | Other | NY | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 254873 (New York) | Primary |
| Provider Name | Michael Yuryev |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174857817 PECOS PAC ID: 7618123456 Enrollment ID: I20120809000349 |
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